D. third intercostal space at the left sternal border.
Rationale: Erb's point is located at the third intercostal space at the left sternal border. The
fi fth intercostal space near the midclavicular line (Option A) is used to listen to the mitral area. The fifth
intercostal space along the left sternal border (Option B) is the location for the tricuspid area. The second
intercostal space at the left sternal border (Option C) is the location for the pulmonic area.
Choose matching term
A nurse failed to administer a medication to a patient according to accepted standards.
Consequently, the
patient suffered adverse effects. Failure to provide patient care and to follow appropriate standards
is called:
1
A. breach of duty.
B. breach of contract.
C. battery.
D. tort
Which interaction style describes a nurse who cannot clearly separate her own emotional responses
from
the patient's needs and wants?
2 A. Holistic
B. Defensive
C. Sympathetic
Certified Medical-Surgical
D. Silence Registered Nurse Sample Questions
1/6
, 8/27/24, 7:51 PM
The nurse is assessing pain in a patient with appendicitis. Which initial statement or question will be
most
effective in eliciting information?
3 A. "Tell me how you feel."
B. "Point to where you're feeling pain."
C. "Does your pain medication relieve your pain?"
D. "Coughing makes your pain worse, doesn't it?"
When locating Erb's point to hear aortic and pulmonic sounds, the nurse should place the
stethoscope at the:
A. fifth intercostal space near the midclavicular line.
4
B. fith intercostal space along the left sternal border.
C. second intercostal space at the left sternal border.
D. third intercostal space at the left sternal border.
Don't know?
Terms in this set (138)
Christine Warren, 45 years old, has a long 1) The stoma appears pale and dry.
history of ulcerative colitis, and non-surgical
treatment no longer relieved her symptoms. Rationale: If there is an adequate blood supply to the stoma, the color is pink or red,
She underwent a total proctocolectomy and and the stoma is moist as a result of mucous production. A pale dry color suggests
a permanent ileostomy 12 hours ago. ischemia of the stoma or bowel and must be reported immediately to the physician.
The nurse should contact the physician With an ileostomy initially after surgery, the output is a loose, dark green liquid that may
immediately if Mrs. Warren has which of contain some blood. The ileostomy usually begins to drain within 24 of surgery at more
these findings? than one liter per day.
1) The stoma appears pale and dry.
2) The stoma appears red and shiny.
3) There is 200 mL of dark green output from
the stoma.
4) There is 50 mL of serosanguinous drainage
from the stoma.
When changing Mrs. Warren's ileostomy bag, 3) Use a solid skin barrier.
the nurse notices that the peristomal skin is
irritated. Rationale: The drainage from the stoma can quickly irritate the surrounding tissue.
Therefore, a solid skin barrier, with a pectin base or karaya wafer that has a measurable
Which of these actions by the nurse would thickness and hydrocolloid adhesive properties, should be applied.
be appropriate before reapplying the
appliance?
1) Wash the area with antiseptic soap and
water.
2) Clean the site with Dakin's solution.
3) Use a solid skin barrier.
4) Obtain an order for a topical antibiotic.
2/6
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